Orthognathic Surgery Flashcards
What is a le fort I procedure?
Above the maxillary process to pterygopalatine plate….
How can the orocedures involved in orthognathic surgery be classified?
Maxillary procedures
Segmental procedures
How is the psychological assessment carried out during the work up?
Body dysmorphic disorder questionnaire.
A BDD is when a person focuses on a tiny aspect of physical appearance that is almost significant.
Important in finding out whether treatment objectives are achievable or even worth pursuing.
What aesthetical analyses should be looked at?
Macroesthetics
- profile, vertical proportions, width, chin-nasal projection, facial widths
Miniesthetics
- smile lines, smile arcs, crwoding, incisor display
Microesthetics
- gingival recontiuring, crowns, etc
What can an increassed nasolabial fold and recessed lower lip imply?
Class ii malocclusio
How can orthognathic treatment planning be detemined?
Hand-wrist radiography (make sure fusion has occured at all the epyphyseal plates)
Basically when growth is completed as further growth will disrupt surgical achievement
Males about late 20s to early 30s
When might orthognathic surgery be considerrd prioor to growth completing?
Cranofacial deformity
Psychological needs
Functional issues
What orthodontic conepts should be considered in tandem with orthognathic surgery?
Opposite treatment objectives
Opposite mechanics
Reverse extraction patterns
Basically, take them down the pathway in which surgery will then be rquired to manage their problems
What are the presurgical orthodontic intraarch treatment objectives with orthognathic surgery?
Class I molars and premolars Incisors in ideal position Close extraction spaces Establish correct incisor and buccal torque Eliminate tooth size discrepency Malocclusioin may look transiently worse
What are the orthodontic objectives during the surgical phase?
Heavy surgical archwires to hold teeth in position
Centric relation records taken by the OMFS team
Model surgery
Acrylic splints - before procedure to assist during operation
Fixation
- intermaxillary
- intra-osseous
Postop care
What are the orthodontic oostsurgical objectives?
Final tooth alognment etc…
What are the complications involved with orthognathic surgery?
Nasal airway - during operation, anthetist needs to change from nasal to orotracheal tube Vessels - inf. alv. artery Infection Pain and swelling Tmj dysfunction
Whata re the dental complications during orthognathic surgery?
Inadequate attache gingivae
Third molar removal - if during surgery high risk of mandibular fracture
Root position, angulation
Surgical complications
Nerve damage - 100% patients have this but most recover. Paresthesia may persist in some patients Non-union Haemorrhage Incomplete sectioning, splits, fracture Condylar displacement, fracture Loss of segments Loss of tooth vitality, root trauma
